Cardiovascular Flashcards
Angina - Exercise/stress treadmill ECG results
ST segment depression - late stage ischaemia
Acute pericarditis - Pain
- Sharp and pleuritic
- Worse on lying flat and better with leaning forward
- Left ant chest or epigastrum
- Radiates to arm (trapezius ridge - share innervation with phrenic N)
- If acute - can be on inspiration
Mitral regurgitation - Ausculation
- Soft S1 (mitral and tricuspid valve closure)
- Pansystolic murmur - from apex to axilla - Intensity =/ severity
- Prominent 3rd extra heart sound (S3) in congestive HF/ LA overload
Hypertension - Pharmacological treatment
Goal = 140/90
ACD pathway
A - ACE inhibitor (Ramipril/Enalapril) / ARB (Candesartan/Losartan)
C - CCB (Nifedipine/Amlodipine) - 1st line if Black/over 55
D - Diuretics - Thiazide (Bendroflumethazide) or loop (Furosemide)
B blocker - B1 selective (Bisoprolol/Metoprolol) if young/intolerant
Action of Heparin
Thrombin and factor Xa inhibitor
Infective Endocarditis - clinical manifestation
FROMJANE
F - fever
R - Roth’s spots (retinal haemorrhages w white clear centres on fundoscopy)
O- Osler’s nodes (tender nodules in digits)
M - Murmur of heart
J - Janeway lesion (haemorrhages and nodules in fingers)
A - Anaemia
N - Nail splinter haemorrhage
E - Embolic skin lesions (black spots)
Blood pressure definition
Cardiac output x Total Peripheral Resistance
Heart failure - Blood Tests
Brain natriuretic peptide (BNP)
- secreted by vesicles
- Response to increased myocardial wall stress
- Correlate w heart failure severity
ACE inhibitor- Bradykinin breakdown
- Dry chronic cough
- Rash
- Anaphylactoid reaction
Angina - Scoring
- Central, tight chest pain w radiation to arms / jaw / neck
- Precipitated by exertion
- Relieved by rest / GTN spray
1/3 = non-anginal
2/3 = atypical
3/3 = typical
QRISK
- Age
- Gender (male)
- Angina/MI in 1st degree relative
- Smoking
- Hypertension
- Hyperlipidaemia
ACE inhibitor + SE
Ramipril
Dry chronic cough
MI - ECG
Few mins 1. Hyperacute T waves 2. ST elevation Few hours 1. T wave inversion 2. R wave voltage decrease 3. Pathological Q waves Few days 1. ST normal Few weeks/mth 1. T wave normal 2. Q wave remains
Heart failure - Symptoms
Cardinal S
- SOB
- Fatigue
- Ankle swelling
Heart failure - CXR
ABCDE A- Alveolar oedema B - Kerley B lines C - Cardiomegaly D - Dilated upper lobe vessels of lungs E - Effusions (pleural)
Tetralogy of Fallot - features
- Large, maligned ventral septal defect (VSD)
- Overriding aorta
- RV outflow obstruction (due to pulmonary stenosis)
- RV hypertrophy
Pericarditis - ECG
- Diagnostic
- Widespread concave upwards (saddle shaped) ST elevation
- Diffuse ST segment elevation in all leads (STEMI - limited to infarcted A)
- PR depression
Atrial Fibrillation - ECG
- No P waves
2. Irregular + rapid QRS complex
Aortic dissection - Clinical presentation
- Sudden onset of severe + central tearing chest pain - radiate to back and down arms (maximal at onset - unlike MI)
- Hypertension
- Acute lower limb ischaemia
- Neurological S - paraplegia (loss of blood supply to spinal cord)
Chronic limb ischaemia - stages
- Asymptomatic
- Intermittent claudication (cramp on exercise)
- Rest pain/nocturnal pain
- Necrosis/gangrene
Hypertension - secondary causes
- Renal disease
- Endocrine - Cushing’s, Conn’s
- Coarctation of aorta
- Drugs –> corticosteroids
Shock - Definition
Acute circulatory failure w inadequate/inappropriate distributed tissue perfusion
Hypoxia +/or inability of cells to utilise O2
Shock - Types
- Cardiogenic
- Septic
- Anaphylactic
- Hypovolaemic
- Neurogenic
Aneurysm - complications
- Rupture
- Thrombosis
- Embolism
- P on other structures
Mitral Stenosis - Heart Sounds
- Diastolic murmur (blood flows over valve)
- Low pitched diastolic rumble at apex
- Lying on L side in held expiration
- Severe = longer - Loud opening S1 snap
- At apex when leaflets still mobile - then softens and disappears
- Abrupt halt in leaflet motion as leaflet tips fuse
- Severe = closer to S2
Aortic stenosis - Heart sounds
- Soft/absent S2
- Prominent S4 - LV hypertrophy
- Ejection systolic murmur - crescendo decrescendo
- Loudness =/ severity
Action of CCB
- Block L type Ca channels
- Dihydroopyridines (felodipine / amlodipine)
- Peripheral arterial vasodilators - Verapamil
- Negative chonotrope (HR) and negative inotrope (Force of contraction) - Diltiazem (both)
NSAID action
- Inhibit cyclooxygenase (COX) - breaks down arachidonic acid to prostaglandin H2 - less thromboxane A2
Warfarin
- Inhibits vit K - prevent clotting
Ventricular tachycardia - Treatment
- B blockers - bisoprolol /atenolol (B1)
- Sustained (>30s)
IV amiodarone
Emergency electrical cardioversion
Furosemide action
Block Na/K/2Cl transporter
ACE inhibitor action
Reduce circulating levels of aldosterone
Pril
Digoxin effect
- Bradycardia
- Increased ectopic activity (extra hearbeats)
- Positive inotrope (increase force of contraction) by increased intracellular Ca
- Slow AV conduction
Chronic Heart Failure - Pharmacology
- ACE inhibitor (ramipril) /ARB
- B blocker (bisoprolol)
- Diuretics
- Loop (ferosemide)
- Bendroflumethiazide
- Aldosterone antagonist (spirolactone) - Digoxin
- Inotropes
B blocker SE
- Bronchospasm
- Heart failure
- Hypotension
- Bradyarrhythmias
Nitrates - SE
- Headache
- GTN spray syncope
- Tolerance
CCB - SE
- -ve chonotrope
- Bradycardia
- AV block
- Postural hypotension - Peripheral vasodilation
- Flushing
- Headache
- Oedema
- Palpitations - -ve inotrope
- Worse cardiac failure - Verapamil = constipation
Alpha 1 adrenoreceptor blocker
Doxazosin
B blocker action
- Reduce O2 demand
- Slow hr
- Reduce force of contraction - Improve O2 distribution
- Slow hr
Glyceryl trinitrate action
- Venodilation
- Reduce venous return to R heart
- Reduce preload
- Reduce work of heart
- Reduce O2 demand
SAN
Dominant pacemaker
Intrinsic rate of 60-100bpm
Fastest depolarising tissue
ECG paper
- Horizontal
- 1 small box = 0.04s
- 1 big box = 0.2s - Vertical
- 1 large = 0.5mV
CO
CO (L/min) = SV (L) x HR (BPM)
Heart sounds
S1 - Mitral/tricuspid valve closure
S2 - Aortic and pulmonary V closure
S3 - Early diastole during rapid ventricular filling
- children, preg, MR, HF
S4 - Gallop in late diastole - blood forced into stiff hypertrophic ventricle - LV hypertrophy
Cardiac failure - Definition
Inability of heart to deliver blood + O2 at a rate that is commensurate w requirement of metabolising tissue of body
Infective endocarditis - causative organisms
- Staph aureus
- Pseudomonas aeruginosa
- Strep viridans (dental problem)
Acute pericarditis - Definition
Acute inflammation of pericardium - w/wout effusion
Hypertension - values
- Normotensive <140/90
- Stage 1
- >140/90
- ABPM/HBPM >135/85 - Stage 2
- >160/100
- 150/95 - Severe
- S>180 +/or D>110
- Immediate Tx
Cardiac arrhythmias - complications
- Sudden death
- Syncope
- HF
- Chest pain
- Dizziness
- Palpitations
- Asymptomatic
RBBB - ECG
- MaRRoW
- QRS like M in V1
- QRS like W in V5+6
LBBB - ECG
- WiLLiaM
- QRS like W in V1-2
- QRS like M in V4-6
Aneurysm - Definition
Permanent dilation of A to twice normal diameter
Acute Lower Limb ischaemia - symptoms
6P's 1. Pain 2. Pallor 3. Perishing cold 4. Pulseless 5. Paralysis 6. Paraesthesia More Ps = more severe
Shock - recognise
- Cold, sweaty, pale, vasoconstricted skin
- Weak/rapid pulse
- Pulse P reduced
- Mean arterial P maintained - Reduced urine output
- Coma
Haemorrhagic Shock Classification
Class I vs Class II vs III
- 15% blood loss vs 15-30 vs 30-40
- Pulse < 100bpm vs >100bpm vs >120
- BP normal in I and II vs decreased
- RR 14-20 vs 20-30 vs decreased
- Urine output >30ml/hr vs 20-30 ml/hr vs 5-15
- Slightly vs mildly anxious vs confused
Peripheral Vascular disease - Classification
Fontaine I = asynical symptoms IIa = mild claudication IIb = mod-severe claudication III = ischaemic rest pain IV = ulceration / gangrene
Cardiac Failure - Classifications
New York Heart Association Class I : No limitation Class II : Slight limitation Class III : Marked limitation Glass IV: Inability to carry out physical activity without discomfort
CHADSVASC score
Chance of stroke in atrial fibrillation
Hypertension - Diagnosis
- Serum creatinine
- eGFR
- Glucose
- ECG –> LV hypertrophy
- Fundoscopy - retinal haemorrhage / papilloedema